Although the literature is limited primarily to retrospective small case series of the operative technique of fifth metatarsal
osteotomies with a short follow-up, some important information can be learned. Stabilization of the
osteotomy with
Kirschner wire fixation appears to decrease dorsal displacement of the distal fragment and distal
osteotomies; this leads to decreased incidence of transfer
metatarsalgia.
Kirschner wire fixation is advocated. The proximal chevron
osteotomy of the fifth metatarsal, although stable, has a 20% delayed union rate, most likely resulting from the unique vascular anatomy in this region. The radiographic and clinical results appear to be compatible between distal and proximal
osteotomies. Based on this information, primary use of a proximal
osteotomy technique is not recommended. The oblique diaphyseal
osteotomy technique requires an incision for the
osteotomy as well as a distal incision at the metatarsophalangeal joint for correction of this joint. Hardware removal was performed in most patients, and the complications included two cases of delayed union. Time to healing was reported to be 8 weeks, 1.5 times the reported time to healing in distal chevron
osteotomies. A significant radiographic correction was noted with the oblique diaphyseal
osteotomy; however, radiographic measurements can be altered with foot position and lack of x-ray standardization and technique. Kitaoka et al found no correlation with the degree of radiographic correction and post-operative clinical symptoms. The authors agree with Kitaoka et al that the oblique diaphyseal
osteotomy should be reserved for patients who fail an initial distal
osteotomy technique. Distal oblique
osteotomies appear to have less stability and more complications with malunion, transfer
metatarsalgia, and delayed union and should be abandoned for a more stable chevron technique. The distal chevron
osteotomy has a small incidence of transfer
metatarsalgia; however, it appears to improve the clinical radiographic appearance of [table: see text] the foot with a shortened time to healing (4 to 6 weeks). A biplanar technique can be employed with a distal chevron
osteotomy to improve plantar
callosity symptoms. More studies are needed to examine critically patient outcomes with uniplanar and biplanar techniques using the distal chevron
osteotomy.